A rare case of ileo-ileal intussusception due to a bleeding lipomatous mass treated by laparoscopic ileal resection.

INTRODUCTION: Adult intussusception is a rare cause of bowel obstruction with atypical presentation. It can be associated with primary or secondary intestinal tumors and, rarely, with lipomatous masses. CASE REPORT: We report the case of a 69-year old man presenting with a history of gastrointestinal bleeding and anemia. Upper and lower endoscopies were negative for bleeding. On abdominal contrast enhanced computerized tomography (CT) scan, a trans-omental hernia in the right lower abdominal quadrant was diagnosed with no active bleeding or evidence of tumor. On exploratory laparoscopy we detected an ileo-ileal intussusception caused by a submucosal mass in the distal ileum, which was reduced and we then performed a segmental resection of the involved small bowel tract. The patient fully recovered by postoperative day 3 when he was discharged home. Final pathology confirmed an ileal lipoma. CONCLUSION: Ileal intussusception caused by lipoma is a rare condition, which can be diagnosed with endoscopy, barium enema, and abdominal ultrasound or CT scanning, but preoperative diagnosis may be difficult. The treatment of choice is the reduction of the intussusception and the resection (laparoscopic or open) of the involved tract. KEY WORDS: Intussusception, Lipoma, Ileum, Laparoscopy, Bleeding.

Prolapsed giant sigmoid lipoma: a rare cause of adult ischaemic intussusception.

Intussusception is a rare cause of obstruction in adults and has a variable, non-specific presentation. Adult intussusception is usually associated with an underlying organic pathology, such as a benign or malignant tumour which acts as the lead point. Prolapse of the lead-point mass through the anal canal is an extremely rare presentation with very few reported cases in the literature. We describe a case of a 67-year-old man who presented with rectal prolapse of a large soft tissue mass. CT of the abdomen and barium enema revealed partial intussusception of an upper sigmoid lipomatous polyp. Examination under anaesthesia was performed and the prolapse reduced. A laparoscopic sigmoid colectomy was planned. The patient subsequently re-presented clinically unwell with a recurrent necrotic prolapsing mass. Laparotomy and sigmoid colectomy was performed and the patient recovered fully. The resected mass was a 7×4.5×4.0 cm necrotic sigmoid lipoma.

Single port laparoscopic right hemicolectomy for ileocolic intussusception.

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

Adult ileoileal intussusception induced by an ileal lipoma diagnosed preoperatively: report of a case and review of the literature.

We herein report a case of adult ileoileal intussusception induced by an ileal lipoma. A 68-year-old woman with a history of small intestinal tumors was admitted to our hospital with severe, colicky lower abdominal pain, similar to episodes experienced in the past. A barium meal enema at the initial admission demonstrated a small intestinal tumor in the ileum 30 cm proximal to the ileocecal valve. Abdominal ultrasound sonography and computed tomography showed a sausage-shaped mass presenting as a target sign in the right lower abdomen, suggestive of intussusception. There was also a round mass of fat attenuation representing a lipoma, which was considered the lead point of the intussusception. The patient underwent emergency surgery and partial resection of the ileum, including the ileal tumor, following reduction of the intussusception. The resected specimen contained a round tumor measuring 1.5 × 1.5 × 1.4 cm, which was diagnosed histopathologically as an intestinal lipoma. The patient made a satisfactory recovery and was discharged on postoperative day 10. The clinical characteristics of previously reported lipomas with intussusception are also discussed, including the relationships between the tumor size and symptoms or location.

Colonic intussusception caused by colonic lipoma: a case report.

Intussusception is a pediatric condition that rarely presents in adults. Colonic lipomas 4 cm and more in diameter can cause colonic intussusception leading to emergency operation. Surgical resection of the involved segment must be the procedure of choice. We report a case of colonic intussusception caused by colonic lipoma in an adult. The patient underwent operation, and histopathological examination of the specimen confirmed the diagnosis of colonic submucosal lipoma.

Colonic lipoma with florid vascular proliferation and nodule-aggregating appearance related to repeated intussusception.

A unique case of repeatedly intussuscepted colonic lipoma mimicking an epithelial tumor in a 50-year-old man is reported. The tumor was located in the ascending colon and was approximately 5 cm in diameter. Colonoscopic and barium-enema examinations suggested a huge epithelial tumor because of its nodule-aggregating appearance. In contrast, computed tomography examination showed a fatty element in the core of the lesion. The biopsy specimens suggested a primary angiomatous lesion because of its pronounced vascular proliferation. Because the presumed diagnoses based on the examinations were different, the preoperative diagnosis was not confirmed. The tumor was composed of intramural lipoma with a multiple polypoid mucosa overlay. This lesion was unique in that the lipoma appeared to be within the muscularis propria and the multiple polypoid appearance of its covering mucosa. The mucosal changes including florid vascular proliferation, fibromuscular obliteration and epithelial regeneration suggested a reparative process, with ischemic damage due to the effects of intussusception being the most likely event. It should be kept in mind that even a simple lipoma can have a unique appearance reminiscent of epithelial tumor when it repeatedly experiences intussusception.

Submucous lipoma of the ileocaecal valve presenting as caecal volvulus.

Caecal volvulus is a well described but unusual condition. We report here, a case of caecal volvulus in a 53-year-old Caucasian woman associated with intussuscepted submucous lipoma of the ileocaecal region. The imaging and pathology are presented. Submucous lipoma of the ileocaecal region is uncommon but well described. It can be mistaken as carcinoma of the ascending colon on barium enema and on computed tomography scan. The combination with caecal volvulus is a rare occurrence.

Adult ileocolic intussusception secondary to a submucosal cecal lipoma.

Intussusception is a relatively common cause of intestinal obstruction in children but a rare clinical entity in adults, representing fewer than 1% of intestinal obstructions in this patient population. We present a rare case of a 44-year-old female patient with intestinal obstruction due to ileocolic and colocolonic intussusception secondary to an intramural cecal lipoma. Diagnosis was made by barium enema and abdominal computed tomography and was confirmed by colonoscopy. After failure of conservative treatment, the patient underwent surgery.

Colonic lipoma intussusception: a case report.

Lipomas are the most common mesenchymal benign tumor of the colon. They are usually asymptomatic but may cause bleeding, obstruction, intussusception, or abdominal pain. The diagnosis can be made by colonoscopy, barium enema examination, and by computed tomography (CT). We have reported a case of large submucosal lipoma of the ascending colon with intestinal obstruction. At laparotomy there was an intussusception descending colon, and subtotal colectomy was performed.

Invaginaciones intestinales en el adulto de causa tumoral / Adult intestinal invaginations of tumoral origin

Propósito: Destacar la importancia de la patología neoplásica como una de las causas más fundamentales de las invaginaciones intestinales en el adulto.• Material y Métodos: Estudio descriptivo restrospectivo de invaginaciones intestinales en nuestro Centro de 1996 a 2000.• Resultados: Se presentaron once casos de invaginaciones (7 mujeres: 4 hombres) con una edad media de 54 años. La clínica más frecuente resultó la obstrucción intestinal, y el diagnóstico preoperatorio fue llevado a cabo en 6 casos, lo más habitual por medio de enema opaco. El tratamiento fue la laparotomía, demostrándose 6 lipomas, 2 adenocarcinomas, un leiomiosarcoma, una metástasis de melanoma cutáneo y un hematoma mural. En 10 casos se realizó resección intestinal según criterios oncológicos.• Conclusiones: En las invaginaciones intestinales en el adulto, son de gran importancia una adecuada sospecha clínica y diagnóstica, porque la correcta terapéutica quirúrgica llevará a su resolución, en cuyo origen subyace muchas veces una patología neoplásica. (AU)

A case of sigmoid lipoma presenting with intussusception.

Colonic lipomas are rare, benign tumours that rarely produce symptoms. Presented here is a case where a sigmoid lipoma acted as lead point to produce intussusception.

Atypical presentation of plantar fasciitis secondary to soft-tissue mass infiltration.

This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient's description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient's pain.

Preoperative diagnosis of ileal lipoma by endoscopic ultrasonography probe.

The occurrence of tumor in the small intestine is relatively rare. It has been demonstrated that lipoma of the ileum is a cause of intussusception. We report a 59-year-old man admitted to our hospital for lower abdominal pain. Diagnosis of intussusception was made by abdominal x-ray and ultrasonography. Enema contrast studies revealed ileocolic intussusception. Colonoscopy revealed a tumor with an submucosal tumor (SMT)-like head and coil-spring appearance in the ascending colon. Endoscopic ultrasonography (EUS) revealed a hyperechoic submucosal lesion with features compatible with lipoma. Subsequently, this was confirmed histopathologically after resection. To our knowledge, this is the first report of preoperative diagnosis of ileal lipoma by EUS.

Lipomas de colon: nuevas aportaciones a su diagnóstico / Colonic lipomas: new contributions to the diagnosis

Introducción. Los lipomas de colon ocupan el segundo lugar dentro de los tumores benignos de colon, son tumores formados por tejido adiposo bien diferenciado, con una estroma fibrosa de sostén. La mayoría de estos tumores son asintomáticos, aunque en ocasiones pueden producir complicaciones urgentes. Casos clínico. Se presentan 7 casos de lipomas de colon, diagnosticados en el Servicio de Cirugía General del Hospital Miguel Servet de Zaragoza, desde enero de 1993 hasta enero de 1997. Se trataba de 3 varones y 4 mujeres, todos ellos por encima de la sexta década de la vida El síntoma clínico que motivó su diagnóstico fue, en 4 pacientes, un cuadro de rectorragias causadas por el propio lipoma y en los otros 3 casos se presentó como un hallazgo causal, en uno de ellos en el marco de una angiodisplasia de colon y en los otros dos tras intervención urgente motivada por oclusión intestinal. En cuanto a su localización, tres de los lipomas se hallaban en el sigma, uno en el colon transverso y los tres restantes en el colon ascendente. Discusión. El lipoma de colon es una tumoración de localización submucosa y con máxima incidencia en ciego y colon ascendente, con escasa tendencia a la malignización. El síntoma clínico más frecuente es el dolor abdominal, seguido de alteraciones en el hábito intestinal y rectorragias. En la mayoría de los pacientes la colonoscopia y el enema opaco son pruebas diagnósticas concluyentes, pero en ocasiones es necesaria la utilización de técnicas más modernas como la ultrasonografía endoscópica y la TACT (tomografía computarizada combinada con aire). Se admite de forma general que el tratamiento quirúrgico de estos tumores debe realizarse cuando sean sintomáticos o si se han complicado de manera urgente. Conclusiones. Los lipomas de colon, aunque son tumoraciones benignas y de baja incidencia, pueden plantear problemas para su diferenciación de procesos neoplásicos malignos y del resto de tumoraciones submucosas, necesitando a veces técnicas diagnósticas definitivas. Su tratamiento debe ser individualizado, conociendo que su tendencia natural es la del crecimiento paulatino hasta alcanzar un tamaño en el que desencadenaría una urgencia quirúrgica, por lo que se puede defender su extirpación en los pacientes en la edad media de la vida y sin factores de riesgo quirúrgico (AU)

Intussuscepçäo colônica por lipoma: relato de dois casos / Colonic intussusception by lipoma: report of two cases

Os autores relatam dois casos de intussuscepçäo colônica causada por lipoma, cuja sintomatologia predominante era dor abdominal tipo cólica, alteraçäo do hábito intestinal com diarréia e hematoquesia. O diagnóstico de intussuscepçäo foi feito por meio de enema opaco e colonoscopia. O primeiro doente foi tratado por laparotomia com ressecçäo segmentar do colo e o segundo por ressecçäo colonoscópica do lipoma. Säo feitos comentários a respeito da sintomatologia, diagnóstico e tratamento